• Niklas Schofer, Fabian J Brunner, Michael Schlüter, Francisco Ojeda, Tanja Zeller, Stephan Baldus, Christoph Bickel, Karl J Lackner, Thomas Münzel, Stergios Tzikas, Sabine Genth-Zotz, Ascan Warnholtz, Felix Post, Till Keller, Britta U Goldmann, and Stefan Blankenberg.
• 1 Department of General and Interventional Cardiology, University Heart Center, Germany.
• Eur Heart J Acute Cardiovasc Care. 2017 Feb 1; 6 (1): 60-68.

BackgroundThe determination of cardiac troponin is essential for diagnosing myocardial infarction. A troponin I assay has recently been developed that provides the highest analytical sensitivity to date.MethodsThe analysis included 1560 patients with chest pain, of whom 1098 were diagnosed with non-coronary chest pain, 189 with unstable angina pectoris and 273 with non-ST-segment elevation myocardial infarction. The troponin I concentration was determined on admission (0 hours) and 3 hours later. The diagnostic algorithm incorporated troponin I elevation above the gender-specific 99th percentile as well as predefined relative or absolute 3-hour changes in the troponin I concentration (delta).ResultsThe diagnostic criterion of troponin I above the 99th percentile resulted in a negative predictive value of 98.0% and 98.2% in men and women, respectively. For rule-in of non-ST-segment elevation myocardial infarction, the use of absolute deltas yielded higher positive predictive values and sensitivities compared to relative deltas. With detection rates of about 85% and 82% in men and women, respectively, non-ST-segment elevation myocardial infarction was diagnosed with a positive predictive value close to 84% in men and 80% in women.ConclusionsThe investigational troponin I assay provides an excellent non-ST-segment elevation myocardial infarction rule out. With gender-specific differences, the application of absolute changes in troponin concentration was superior to relative changes to rule in patients with non-ST-segment elevation myocardial infarction.

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